Pop Warner Little Scholars, Inc.
586 Middletown Blvd. Suite C-100 • Langhorne • PA • 19047
Phone: 215-752-2691 • Fax: 215-752-2879
www.popwarner.com
POP WARNER TACKLE FOOTBALL
2011 LEAGUE REGISTRATION FORM
This registration form must be received at Pop Warner Little Scholars (PWLS) on or before September 30, 2011. If a League takes Pop
Warner Insurance, this form must be received at the same time, or prior to, receipt of the insurance application.
League/Conference Name:
NUMBER OF TEAMS
If your LEAGUE has Member Associations, complete the Association Listing on the back before you write totals below.
Traditional Spirit
Squads
Football Teams Cheer Dance
Tiny-Mite Tiny Mite
Mitey Mite Mitey Mite
Junior Peewee Junior Peewee
Peewee Peewee
Junior Midget Junior Midget
Midget Midget
Jr. Bantam/Bantam Jr. Bantam/Bantam
Unlimited Unlimited
TOTALS 0 TOTALS 0 0
COMPUTE YOUR REGISTRATION FEE
0 Football Teams X $30.00 per team $0.00 (A)
Please note: There will be a $25 fee for returned
0 Traditional Spirit Squads X $25.00/squad $0.00 (B) checks and a $5 penalty per team for Registration
Amount due to Pop Warner Little Scholars: $0.00 (A + B) received after October 1, 2011.
Make Check payable to PWLS, Inc.
*Note: Year-Round Cheer Medical and Registration due by February 1, 2011
*Note: Year-Round Cheer Medical and Registration due by February 1, 2011.
Refunds may be given for teams registered, but never certified. All refund requests must be in writing on your official stationary, and
must be received at PWLS on or before October 1, 2011.
INSURANCE INFORMATION
You must provide proof of insurance for both of medical, liability and sexual abuse liability. Acceptable proof for medical is a copy of
the actual policy: for liability, a certificate of insurance. Copies of insurance applications are NOT acceptable proof.
OFFICIAL SIGNATURE REQUIRED
As a duly authorized official of the organization, I affirm all information provided herein and attached is true and correct to the best of my
ability and belief. I pledge our compliance with all Pop Warner playing and administrative rules and procedures as outlined in the rule
book, administrative manual and bylaws. I hereby understand and acknowledge that all civil disputes between Pop Warner and any and
all affiliated parties will be subject to binding arbitration in the locale of the Pop Warner Little Scholars, Inc. National Office in
Langhorne, PA in accordance with Pennsylvania law under the guidelines and rules of the American Arbitration Association. I hereby
agree that this binding arbitration shall be in lieu of any litigation by and between myself, Pop Warner and any and all affiliated parties. I
also understand and agree that if I contest any decision or ruling of Pop Warner Little Scholars, Inc. and seek other recourse, that I will
reimburse Pop Warner for all legal fees and expenses it reasonably incurs. If any portion of this application shall be deemed
unenforceable or invalid, the reminder shall remain in full force and effect.
Signed: Date:
Printed Name: Title:
Phone Number: Email:
(1/11) Mail form and check to Pop Warner Little Scholars – 586 Middletown Blvd. – Suite C-100 – Langhorne, PA 19047
League/Conference Name:
Association Listing:
If you are a League with sub-member associations, fill in the boxes below. For each association, enter the
number of teams and cheer squads by division of play. If you need more space (ie., have more than 6 associations), copy this blank page, then
complete and attach the additional page(s).
ASSN: ASSN:
Football TM MM JP PW JM M JB Football TM MM JP PW JM M JB
Cheer TM MM JP PW JM M JB Cheer TM MM JP PW JM M JB
Dance TM MM JP PW JM M JB Dance TM MM JP PW JM M JB
Football B U Football B U
Cheer B U Cheer B U
Dance B U Dance B U
ASSN: ASSN:
Football TM MM JP PW JM M JB Football TM MM JP PW JM M JB
Cheer TM MM JP PW JM M JB Cheer TM MM JP PW JM M JB
Dance TM MM JP PW JM M JB Dance TM MM JP PW JM M JB
Football B U Football B U
Cheer B U Cheer B U
Dance B U Dance B U
ASSN: ASSN:
Football TM MM JP PW JM M JB Football TM MM JP PW JM M JB
Cheer TM MM JP PW JM M JB Cheer TM MM JP PW JM M JB
Dance TM MM JP PW JM M JB Dance TM MM JP PW JM M JB
Football B U Football B U
Cheer B U Cheer B U
Dance B U Dance B U
The information provided above will be used for team count, registration, insurance and roster verification.
Subtotals from this page:
Football TM MM JP PW JM M JB B U
Cheer TM MM JP PW JM M JB B U
Dance TM MM JP PW JM M JB B U
Pop Warner Little Scholars, Inc.
586 Middletown Blvd. Suite C-100 • Langhorne • PA • 19047
Phone: 215-752-2691 • Fax: 215-752-2879
www.popwarner.com
POP WARNER FLAG FOOTBALL AND SPIRIT
2011 REGISTRATION FORM
This registration form must be received at Pop Warner Little Scholars (PWLS) on or before September 30, 2011. If a League takes Pop
Warner Insurance, this form must be received at the same time, or prior to, receipt of the insurance application.
League/Conf. Name:
All divisions will use August 1st Cut off date
Please enter # of flag teams per division on left and # of flag spirit squads on right:
Flag Teams Spirit Teams
CUB
BOBCAT
WILDCAT
CHALLENGER
0 0
Total Total
COMPUTE YOUR REGISTRATION FEE:
0 Flag Teams X $15.00 = $0.00 amount due. Make Check payable to: PWLS
0 Spirit Teams X $15.00 = $0.00 amount due. Make Check payable to: PWLS
Please note: There will be a $25.00 fee for returned checks and $5.00 penalty per team for Registration received after October 1,
2011.
Refunds may be given for teams registered, but never certified. All refund requests must be in writing on your official
stationary, and must be received at PWLS on or before October 1, 2011.
INSURANCE INFORMATION:
If you are taking Pop Warner Insurance… and the number of teams on your insurance application differs from the number of
teams above, please attach an explanation to your application form.
If you are not taking Pop Warner Insurance, please complete the following:
1. Name of Medical Insurance Company:
2. Name of Liability Insurance Company:
3. You must provide proof of insurance for both of these carriers. Acceptable proof for medical is a copy of the actual policy:
for liability, a certificate of insurance. Copies of insurance applications are NOT acceptable proof.
OFFICIAL SIGNATURE REQUIRED:
As a duly authorized official of the organization, I affirm all information provided herein and attached is true and correct to the best of my ability and
belief. I pledge our compliance with all Pop Warner playing and administrative rules and procedures as outlined in the rule book, administrative
manual and bylaws. I hereby understand and acknowledge that all civil disputes between Pop Warner and any and all affiliated parties will be
subject to binding arbitration in the locale of the Pop Warner Little Scholars, Inc. National Office in Langhorne, PA in accordance with Pennsylvania
law under the guidelines and rules of the American Arbitration Association. I hereby agree that this binding arbitration shall be in lieu of any
litigation by and between myself, Pop Warner and any and all affiliated parties. I also understand and agree that if I contest any decision or ruling
of Pop Warner Little Scholars, Inc. and seek other recourse, that I will reimburse Pop Warner for all legal fees and expenses it reasonably incurs.
If any portion of this application shall be deemed unenforceable or invalid, the reminder shall remain in full force and effect.
Signed: Date:
Printed Name: Title:
Phone Number: Email:
(1/11) Mail form and check to Pop Warner Little Scholars – 586 Middletown Blvd. – Suite C-100 – Langhorne, PA 19047